FESALBON, MARY GEM G. Patients Name : M.E.

B Age : 37 years old Medical Diagnosis : Pulmonary Tuberculosis Nursing Diagnosis : Ineffective breathing pattern related to acute infection and decreased lung capacity. Short Term Goal : After 30mins. to 1 hour of nursing intervention the patient breathing will return to normal rate and pattern Long Term Goal : After 2-3 days of nursing interventions, there should be no signs of infection Cues Subjective: (n/a) OBJECTIVE: Nonproductive cough at first but later produces sputum and progresses to hemoptysis. Crackles Pleuritc pain Dyspnea VS as follows - RR of 31 - PR:89 - BP: 110/70 - Temp. :36.2 Nursing Diagnosis Ineffective breathing pattern related to acute infection and decreased lung capacity. Scientific Reason The risk of TB is a higher in older people who have close contact with a newly diagnosed TB patient, those who have TB before, gastrectomy patients, and those affected with diabetes mellitus. The aging process weakens the immune system, further increasing the likelihood of tubercular infection in older adults. Transmission occurs when droplet nuclei are produced form an infected persons coughs or sneezes. If inhaled, tubercle bacillus settles in the alveolus and infection Planning SHORT TERM : After 30mins. to 1 hour of nursing intervention the patient breathing will return to normal rate and pattern Long Term: After 2-3 days of nursing interventions, there should be no signs of infection Administer oxygen therapy as ordered. Nursing intervention Independent Rationale Evaluation STANDARD After 30mins. to 1 hour of Respiratory status nursing assessment helps intervention gauge the patients the patient severity and breathing l whether its returned to progressing. normal rate and pattern; To provide relief from 31cpm from symptoms of to 16-20 cpm hypoxemia and hypoxia. ABG levels and continuous pulse oximetry measures the bloods oxygen content and are good indicators of the lungs ability to oxygenate the blood. CRITERIA After 30mins. to 1 hour of nursing intervention the patient breathing l returned to normal rate Monitor ABG levels and oxygen saturation as ordered. and pattern; from 31cpm to 22 cpm

Monitor respiratory status, including vital signs, breath sounds, and skin color.

occurs, with alveolocapillary dilation and endothelial swelling. The incubation time for TB is 4 to 8 weeks. TB is usually asymptomatic in primary infection

Place the patient in semi-fowlers position and place the diaphragm in proper position to contract.

To increase chest expansion and to alleviate dyspnea.

Dependent Source: Pathophysiology for the health professions by Barbara Gould Collect sputum samples as ordered To monitor the progress of the disease and treatment.